Registered Nurse Care Manager

RN - Care ManagerEmergency Department Care Manager RN position within the MetroPlus Health Plan Case Management Program. Non-patient facing role; no medical compliance requirements. Leadership experience preferred. PRI and Screen certification must be obtained within three months of employment.Experience: Minimum of 5 years of clinical experience as a Registered Nurse. Minimum of 2 years of experience in a healthcare setting, Care Management, or Managed Care setting. Experience with Care Coordination, Utilization Review, and Discharge Planning. Leadership experience preferred. Ability to read and interpret medical records, claims data, pharmacy records, laboratory reports, and prescriptions. Ability to work closely with members and caregivers.Required Skills: Care Management. Managed Care. Care Coordination. Utilization Review. Discharge Planning. Healthcare Management. Clinical Documentation. Medical Record Review. Claims Review. Medication Reconciliation. Chronic Disease Management. Transitional Care. Social Determinants of Health. Microsoft Office. Computer Literacy.Education: Bachelor's Degree required. Master's Degree preferred.Licenses & Certifications: Active New York State Registered Nurse (RN) License required. PRI and Screen certification required within three months of employment. Certification in Case Management preferred. Bilingual Spanish preferred.Languages: English (Read, Write, Speak).Job Summary: The primary goal of the Care Manager is to optimize members' healthcare and care delivery experience while improving quality of care and reducing unnecessary healthcare costs. The Care Manager assesses members' clinical, psychosocial, financial, and environmental needs, collaborates with the interdisciplinary care team, develops individualized plans of care, coordinates services, and evaluates outcomes throughout the continuum of care.Job Responsibilities: Assess members' clinical, psychosocial, financial, and environmental needs. Develop, implement, and evaluate individualized plans of care in collaboration with members, caregivers, providers, and the interdisciplinary care team. Participate in interdisciplinary rounds and communicate plans of care with primary care providers. Coordinate care transitions and provide transitional care management. Address gaps in care and connect members with appropriate community resources and support services. Assess and address social determinants of health impacting member care. Educate members on chronic disease management, preventive care, medication management, medication reconciliation, medication adherence, and home safety. Provide complex care management to improve access to care, reduce unnecessary hospitalizations, and coordinate appropriate referrals. Advocate for members by assisting them with informed healthcare decisions and treatment options. Review and interpret medical records, claims, laboratory reports, pharmacy information, and prescriptions to support care management activities. Maintain accurate, comprehensive, and current clinical and non-clinical documentation in the Care Management System (DCMS). Use data to monitor, track, and trend clinical outcomes and care management activities. Maintain professional competencies and comply with all organizational policies, procedures, orientation requirements, and mandatory training. Perform other duties as assigned by the Care Manager Team Lead or Manager.Professional Competencies: Integrity and Trust. Customer Focus. Strong verbal and written communication skills. Motivational coaching, influencing, and negotiation skills. Time management and organizational skills. Strong critical thinking and problem-solving skills. Ability to prioritize and manage changing priorities under pressure. Proficiency navigating multiple web-based systems and Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook. Ability to build effective working relationships with members, caregivers, providers, and interdisciplinary teams. Detail-oriented, resourceful, proactive, and solution-driven.